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Fieldwork - Remediation Ideas - Therapeutic Handling
Occupational Therapy
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When a student is having difficulty with therapeutic handling, he/she is not effectively using his/her hands to guide the client’s motor control. The student may not be sure of what to do with his/her hands, where to place the hands, how to normalize the tone with the hands, or how to change the response the client is showing to him/her. This is a skill that requires much guided practice to comprehend and master. Most likely the student has practiced most of these techniques on primarily normal bodies (their classmates and family members). This may be the first time he/she really feels spasticity or flaccidity. There are many things the fieldwork supervisor can do to help the student reason through the process and practice it.

  1. Have the student write up a plan on paper with specifics about what they need to do. Have the student list muscle groups or specific muscles that have abnormal tone. Next identify the type of abnormal tone. Next identify specific handling techniques to use to normalize the tone. Lastly identify positions to do these techniques in. Review the table with the student before the session begins and provide feedback.


  2. Muscles

    Type of Tone

    Handling technique to normalize tone

    Positions to consider

  3. Have the student practice the procedure on another person with a normal body. Have the student identify bony landmarks, palpation of muscle bellies, place his/her hands in manner to facilitate movement. You may have the “client” move in specific ways such as reaching in various planes and ask the student to identify the changes he/she feels in specific muscles when the patient actively moves.

  4. Have the student practice some techniques on you. Provide immediate feedback during the process and identify what the student is doing correctly and incorrectly. Factors to consider are the weight of the hand on you, the amount of pressure, the gliding of his/her hands to promote your movement, and the support provided proximally to help maintain balance when needed. Some describe this process as a dance. The student must provide the right cues to help you gently move.

  5. Role model specific techniques on a client and ask the student questions during the process. It’s best if you tell the student about this activity ahead of time to ease anxiety. You can ask him/her to identify where your hand it placed, which techniques you are implementing, which muscles show a change in tone, why you moved your hand to a new location or changed your technique.

  6. Refer them back to the textbooks to review the motor control theories (Bobath, Brunnstrom, Rood, PNF) and be prepared to discuss these as a compare and contrast question.

  7. When the student verbalizes the information correctly but seems impatient with the techniques, he/she may be under the impression it is an all or nothing concept. Explain that relaxation may take twenty minutes or longer in some patients. Relaxation may occur in stages for some patients as you work your way proximally to distally. Review the benefits of slow steady stretching to elongate muscles to prepare them to move.

  8. Have the student practice with you a variety of clients with various stages of recovery and different types of abnormal tone. The more the student feels, the more he/she will understand the normal movement process.

  9. There are some commercially available videos of therapists demonstrating handling techniques on a client. Have the student watch the video and describe what they see and what they learned. If you do not have any available in your department, consider making one or call the Academic Fieldwork Coordinator at the University of South Alabama to request to borrow one.
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